AIDS risk and prevention among adolescents

https://doi.org/10.1016/0277-9536(91)90446-JGet rights and content

Abstract

Although relatively few teenagers have been diagnosed with AIDS and the extent of asymptomatic human immunodeficiency virus (HIV) infection among adolescents remains largely unknown, there is cause for concern about teens' risk of contracting HIV disease. The incubation period (the time from initial infection to the development of full-blown AIDS) is estimated to average eight years, and therefore it is probable that most of the individuals in their twenties who have AIDS (20% of all the people with AIDS) contracted HIV during their teenage years. The sexual and drug use activities of many teenagers place them at increased risk for HIV transmission. Sexually transmitted diseases (STDs) are pervasive and a major cause of morbidity among sexually active adolescents. The rates of STDs have continued to rise even during the ‘age of AIDS’. These rates are of concern since the behaviors associated with the acquisition and transmission of STDs are also the behaviors associated with HIV transmission. In addition, the presence of STDs may increase the likelihood of HIV transmission.

Although condoms reduce the risk of HIV transmission, their use remains low among sexually active teenagers. Reducing or eliminating high risk behaviors is the only way to limit further spread of HIV. Effective prevention programs should be based on models and theories of risk behavior so that the programs can be designed to change those factors which lead to the undesirable risky behaviors. The AIDS Risk Reduction Model (ARRM) is presented as an example of such a social-physiological model. The ARRM model characterizes why people persist in engaging in high risk activities or make efforts to alter those activities. The three stages theorized to be necessary to reduce risky sexual activities are: (1) recognizing that one's activities make oneself vulnerable to contracting HIV; (2) making the decision to alter risky sexual behaviors and committing to that decision; (3) overcoming barriers to enacting the decision, including problems in sexual communication and seeking help when necessary to learn strategies to reduce risky behaviors. Each stage includes a number of constructs identified in prior research as important for engaging in ‘healthy’ or low risk behaviors.

Innovative strategies must be developed and implemented to reach all adolescents, ranging from teenagers who attend school and live with their families to those teens who are runaways, live in detention facilities or are otherwise ‘disenfranchised’. To be most effective, HIV prevention programs must utilize strategies which combine cognitive and behavioral skills training. These programs must be designed to be age appropriate and sensitive to cultural values, religious beliefs, sex roles, and customs within adolescent groups. In addition, these programs should utilize a variety of communication strategies, and importantly, be evaluated for their effectiveness in preventing and reducing HIV risk behavior.

References (135)

  • E. Goodman et al.

    Acquired immunodeficiency syndrome and adolescents: Knowledge, attitudes, beliefs and behaviors in a New York City Adolescent Minority Population

    Pediatrics

    (1989)
  • J. Brooks-Gunn et al.

    Preventing HIV infection and AIDS in children and adolescents: Behavioral research and intervention strategies

    Am. Psychol.

    (1988)
  • J.A. Flora et al.

    Reducing the risk of AIDS in adolescents

    Am. Psychol.

    (1988)
  • L. Strunin et al.

    Acquired immunodeficiency syndrome and adolescents: knowledge, beliefs, attitudes, and behaviors

    Pediatrics

    (1987)
  • R.J. DiClemente et al.

    Adolescents and AIDS: A survey of knowledge, attitudes, and beliefs about AIDS in San Francisco

    Am. J. publ. Hlth

    (1986)
  • R.J. DiClemente et al.

    Minorities and AIDS: Knowledge, attitudes, and misconceptions among Black and Latino adolescents

    Am. J. publ. Hlth

    (1988)
  • R. Hingson et al.

    Knowledge about AIDS and behavior change among minority groups in Massachusetts

  • N. Reuben et al.

    The relationship of high risk behaviors to AIDS knowledge in adolescent high school students

  • Centers for Disease Control

    HIV/AIDS Surveillance Report

    (June 1990)
  • S.H. Vermund et al.

    Adolescent AIDS in New York: Predominance of sexual and drug-related transmission

  • G.F. Lemp et al.

    Projections of AIDS morbidity and mortality in San Francisco using epidemic models

  • Centers for Disease Control

    Human immunodeficiency virus in the United States

    Morbid. Mortal. Wkly Rep.

    (1988)
  • S.H. Vermund et al.

    Heterosexually acquired AIDS in New York adolescents

  • S.H. Vermund et al.

    Acquired immunodeficiency syndrome among adolescents: Case surveillance profiles in New York City and in the rest of the United States

    Am. J. Dis. Child.

    (1989)
  • J.F. Brundage

    AIDS in the tri-state area: A regional portrait of the epidemic (Montefiore Hospital Annual Symposium on AIDS)

    Bull. Acad. Med. N.Y.

    (1987)
  • M.R. Peterson et al.

    Trends in human immunodeficiency virus infection among civilian applicants for military service—United States October 1985–March 1988

    J. Am. med. Ass.

    (1988)
  • Centers for Disease Control

    Quarterly report to the Domestic Policy Council

    Morbid. Mortal. Wkly Rep.

    (1988)
  • T.C. Quinn et al.

    Human immunodeficiency virus infection among patients attending clinics for sexually transmitted diseases

    N. Engl. J. Med.

    (1988)
  • J. Kennedy

    Testimony before the President's Commission on the HIV epidemic, Washington, DC

    (May 17, 1988)
  • K.K. King

    Heterosexual transmission of HIV: current evidence and future prospects

  • D.W. Cameron et al.

    Female to male heterosexual transmission of HIV infection in Nairobi

  • R.M. Greenblatt et al.

    Genital ulceration as a risk factor for human immunodeficiency virus infection in Kenya

  • J.K. Kreiss et al.

    AIDS virus infection in Nairobi prostitutes: Spread of the epidemic to East Africa

    N. Engl. J. Med.

    (1986)
  • P. Piot et al.

    Heterosexual transmission of HIV

    AIDS

    (1987)
  • J.N. Simonsen et al.

    Human immunodeficiency virus infection among men with sexually transmitted diseases

    N. Engl. J. Med.

    (1988)
  • F. Kroger et al.

    STD education: challenge for the 80's

    J. Sch. Hlth

    (1981)
  • Centers for Disease Control. Personal communication, July...
  • T. Bell et al.

    The adolescent and sexually transmitted disease

  • T.A. Bell et al.

    Age-specific risks of syphilis, gonorrhea, and hospitalized pelvic inflammatory disease in sexually experienced U.S. women

    Sexually Transmitted Disease

    (1984)
  • M.A. Shafer et al.

    Chlamydial trachomatis: Important relationships to race, contraceptive use, lower genital tract infection, and papanicolaou smears

    J. Pediat.

    (1984)
  • Metropolitan Insurance Company

    Sexually transmitted diseases in the U.S.

    Stat. Bull.

    (1986)
  • A.E. Washington

    Pelvic inflammatory disease in adolescents

    Research Highlights

    (1986)
  • J.B. Hardy

    Sexually transmitted diseases among adolescents

    Maryland Med. J.

    (1987)
  • D.A. Grimes

    Deaths due to sexually transmitted diseases

    J. Am. med. Ass.

    (1986)
  • M. Guinan

    Sexually transmitted diseases may reverse the “revolution”

    J. Am. med. Ass.

    (1986)
  • J.G. Lossick

    Epidemiology of sexually transmitted diseases

  • T. Alexander-Rodriguez et al.

    Gonorrhea and syphilis in incarcerated urban adolescents: prevalence and physical signs

    Pediatrics

    (1987)
  • K.R. O'Reilly et al.

    Adolescence and sexual behavior: trends and implications for STD

    J. Adoles. Hlth Care

    (1985)
  • M. Zelnik et al.

    First intercourse among young Americans

    Family Planning Perspectives

    (1983)
  • S.D. Clark et al.

    Sex contraception and parenthood

    Family Planning Perspectives

    (1984)
  • Cited by (0)

    View full text